5 Austin Doctors on their Toughest Cases

These physicians open up about the greatest challenges of their careers, including a grisly car crash and a mysterious personality shift

As Told to Chad Swiatecki | photography by dennis burnett

Published: January 6, 2018

(page 5 of 5)

“He Was Cut in Half”

By Dr. Oscar Rios

If you were to tell this story to another person, they wouldn’t believe you. They’d think this was a lie. It was an automobile accident in 2013, with a male in his 30s. If you look at all the injuries he’d suffered, he should have been dead.

There are certain things that you see in this job that make you feel “This is not right. This is not good.” When I first saw him, I was immediately thinking about having to inform his family about his death, telling them what had happened.

He was cut in half. The crash was at great speed, and because of the impact of the vehicle, his seat belt folded his body and almost split him in two. Some of the main arteries that go to his neck were injured in different places. He had a liver injury. He had a spleen injury. His portal vein was torn, leading to a major hemorrhage. He had his colon transected in half. He had no abdominal wall left.

The only thing keeping him alive was his vertebral column, which somehow had stayed attached. Otherwise he’d have been completely split in half. I can’t tell you why he was alive, but he was.

A lot of what we do in our heads in a trauma center is rhythm based, and it’s very much like, “OK. You know the first thing you need before you do anything else is to establish an airway.” Because when the patient isn’t breathing, he’s going to die no matter what you do. So that’s part of your algorithm. It’s “OK, first is the airway.”

Now we know he’s breathing. Now we look at things like vascular, the state of the blood vessels. We look at blood circulation. He was in shock. We didn’t have time to figure out what else he was dying from. He had seconds for us to go to the operating room and figure it out there.

It was then that we made an incision with a knife and looked. We didn’t believe what we were seeing. He had active bleeding from his portal vein, he had active bleeding from his liver. His pancreas was injured. Two of three layers of his aorta were destroyed. He had no abdominal muscles left to keep him together, and so now we’re just staring at the spine. To somebody who has never seen that, they don’t believe you when you tell them about it. So where to start? Anywhere. You kind of start with an incision, and you figure it out.

I don’t recall the length of time it took, and, you know, somebody can say we were in there for five hours, or they could say however long, but you just lose track of time when you’re in the OR. You forget that you’re tired. You forget that you’ve been awake for a while, forget about time. You just kind of do what you’ve got to do to stop the bleeding and stop them from getting worse.

Part of being a Level 1 trauma center is that there has to be 24-hour-a-day coverage in this hospital by a trauma surgeon. So if it hadn’t been me, it would have been the next guy, who would have done as good a job as I did.

The patient survived, and I told him that a year later this would seem like a distant memory. He had 21 surgeries. He never gave up. The family always thought that he was going to make it. His will to live, I think, carried him through it, because by all definitions he should have died at the scene.